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BJOG. 2007 Nov;114(11):1368-75.
Is misoprostol a safe, effective and acceptable alternative to
manual vacuum aspiration for postabortion care? Results from a
randomised trial in Burkina Faso, West Africa.
Dao B, Blum J, Thieba B, Raghavan S, Ouedraego M, Lankoande J,
Winikoff B.
Centre Hospitalier National Souro Sanou, Bobo Dioulasso, Burkina
Faso.
Objectives:
Previous research has demonstrated the effectiveness
of misoprostol for treatment of incomplete abortion; however,
few studies have systematically compared misoprostol's
effectiveness with that of standard surgical care. This study
documents the effectiveness of a single 600 micrograms dose of
oral misoprostol versus manual vacuum aspiration (MVA) for
treatment of incomplete abortion in a developing country
setting.
Design:
Open-label randomised controlled trial.
Setting:
Two university teaching hospitals in Burkina Faso, West
Africa. POPULATION: Women of reproductive age presenting with
incomplete abortion. Methods:
From April 2004 through October
2004, 447 consenting women with incomplete abortion were
randomised to either a single dose of 600 micrograms oral
misoprostol or MVA for treatment of their condition. MAIN
OUTCOME MEASURE: Completed abortion following initial treatment.
Results:
Regardless of treatment assigned, nearly all
participants had a complete uterine evacuation (misoprostol =
94.5%, MVA = 99.1%; relative risk [RR] = 0.95 [95% CI
0.92-0.99]). Acceptability and satisfaction ratings were similar
and high for both misoprostol and MVA, with three out of four
women indicating that the treatment's adverse effects were
tolerable (misoprostol = 72.9%, MVA = 75.8%; RR = 0.96 [95% CI
0.86-1.07]). The majority of women were 'satisfied' or 'very
satisfied' with the method they received (misoprostol = 96.8%,
MVA = 97.7%; RR = 0.99 [95% CI 0.96-1.02]), expressed a desire
to choose that method again (misoprostol = 94.5%, MVA = 86.6%;
RR = 1.09 [95% CI 1.03-1.16]) and to recommend it to a friend (misoprostol
= 94.5%, MVA = 85.2%; RR = 1.11 [95% CI 1.04-1.18]). Conclusion:
Six hundred micrograms of oral misoprostol is as safe and
acceptable as MVA for the treatment of incomplete abortion.
Operations research is needed to ascertain the role of
misoprostol within postabortion care programmes worldwide.
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